Multiple ruptured cerebral aneurysms at the National Hospital of the Kyrgyz Republic between 2008 and 2014: a departmental summary.

Despite the rapid progress of vascular neurosurgery with the development of microsurgical and endovascular techniques, the optimal strategy for surgical treatment of multiple cerebral aneurysms has not yet been developed. The indications for choosing one-stage or multi-stage surgery remain unsolved. This is a summary of the departmental routine reports at the Clinic of Neurosurgery, National Hospital of the Kyrgyz Republic. Subjects were 235 patients (124 males and 111 females) with ruptured multiple cerebral aneurysms admitted to the hospital. Their ages ranged from 18 to 72 years (average and standard deviation: 44.3 ± 9.7 years) and 48.1% of patients had 3 or more aneurysms. Among aneurysms that ruptured, 20.4% were a giant aneurysm (>25 mm) and 43.0% of patients had grade IV or V according to the Hunt-Hess Scale. Among 228 patients who were operated on, 147 were treated by single-stage surgery and 81 by multi-stage surgery. Microsurgical operations with clipping of the aneurysm neck were performed in 141 (61.8%) patients (97 single-stage and 44 multi-stage), while 40 (17.5%) patients (16 single-stage and 24 multi-stage) were operated using the endovascular technique. The number of palliative surgeries (trapping, ligation of the internal carotid artery, and reinforcement of the aneurysm wall) was significantly less (p=0.011) with multi-stage surgery (9 out of 81 cases, 11.1%) than with single-stage surgery (38 out of 147 cases, 25.9%). Among 600 aneurysms, 583 (97.2%) were treated by either single-stage surgery (n=296) or multi-stage surgery (n=287). There were no differences in prognosis at discharge between single-stage and multi-stage surgery.

Knowledge, attitude, and usage pattern of tobacco among high school students in Nay Pyi Taw, Myanmar.

In Myanmar, although the law prohibits the sale of tobacco products to and by those aged less than 18 years, the use of smoking and smokeless tobacco among high school students is a social problem. There has been no previous study on tobacco use or knowledge of tobacco law among students in Nay Pyi Taw. A survey was conducted to assess the knowledge, attitude, and usage pattern of tobacco among high school students in Nay Pyi Taw, Myanmar. The data were collected in three high schools, from 300 students of Grade 10 and 11, in September 2015, using anonymous self-administered questionnaires which included characteristics of students, knowledge, attitude, and usage pattern of tobacco. Of the 300 students, 104 (34.7%) were smokers and 85 (28.3%) were users of smokeless tobacco. The average age of first use of tobacco was 14 years. Although most students knew about the ill effects of tobacco, only 25% knew about the Tobacco Product Law. The most common source of tobacco was friends and male family members were main smokers in families. Most students had seen male teachers and headmasters smoking in schools. The usage of tobacco and smokeless tobacco was associated with sex and the students' attitude towards tobacco. This study indicated that the high school students knew about the ill effects of tobacco, but not about the Tobacco Product Law. Schools need to educate students and teachers about tobacco and the Tobacco Product Law and the enforcement of the law is also needed.

Estimated costs for treatment and prophylaxis of newborn vitamin K deficiency bleeding in Tashkent, Uzbekistan.

Vitamin K deficiency bleeding (VKDB) is a preventable cause of infant mortality and long-term morbidity through the world. This study aimed to demonstrate the costs of VKDB treatment estimated from the hospital records in Tashkent, Uzbekistan, as well as the prophylaxis costs for mass vitamin K medication. Subjects were 50 patients with no operation and 50 patients who had received a brain operation, consecutively enrolled from 180 cases diagnosed at Republican Research Center of Emergency Medicine in 2014. In that year, an additional 22 VKDB patients were found in Tashkent; the incidence of VKDB was 478/100,000 among 42,225 newborns. The prophylaxis costs for all newborns in Tashkent were estimated under a plausible condition. The average age at admission was 43.2 days among 100 patients (67 boys and 33 girls) with birth weight from 2,600 g to 3,800 g (3,105 g on average). The great majority of patients (92.0%) were breastfed; 89.5% in boys and 97.0% in girls. Average treatment cost per VKDB patient was 365 USD for the operated and 285 USD for the non-operated. Total expenses of the 202 patients were estimated to be 64,603 USD. A single prophylaxis was estimated to cost 1.24 USD, totaling 52,359 USD for the prophylaxis of 42,225 newborns. Since the reduction of VKDB incidence through prophylaxis is considered to be higher than 78.5% (52,359/64,603), provision of prophylaxis services would reduce the total costs of VKDB treatment in Uzbekistan, where prophylaxis is not provided.

Assessment of knowledge about snakebite management amongst healthcare providers in the provincial and two district hospitals in Savannakhet Province, Lao PDR.

Snakebite is a neglected condition and a common public health problem in Lao People's Democratic Republic (Lao PDR), with a high incidence of up to 1,105 cases per 100,000 persons per year. Snakebite patients with systemic envenoming do not receive effective treatment at local health facilities. Healthcare providers have only limited knowledge in assessing and providing the correct treatment for venomous snakebites. A cross-sectional study was conducted among 119 healthcare providers in Savannakhet Province, Lao PDR, with respect to their socio-demographic characteristics, knowledge of snake identification, and management of snakebite. Data was analyzed using SPSS. Logistic regression was performed to estimate the odds ratios (OR) and 95% confidence intervals (CI) of adequate knowledge for treating snakebites among the healthcare providers. Among 119 participants, 27.7% and 45.4% had an adequate knowledge of snake identification and management of snakebites, respectively. Approximately 59% could correctly identify symptoms of envenomation, and 19.3% expressed confidence in treating snakebites. Study participants who had received training achieved significantly better snake identification results compared to those without training, with an OR of 2.54 (95% CI: 1.02-6.28). In particular, physicians achieved significantly better results compared to nurses in knowing how to manage snakebites, with an OR of 2.31 (95% CI: 1.04-5.12). Given the level of inadequate knowledge of snakebite management among healthcare providers in the province, more training in snakebite management is needed. University and Health Science Colleges should include snakebite management into the curriculum, to ensure that medical graduates have the appropriate knowledge and skills to treat snakebites.

Knowledge of free delivery policy among women who delivered at health facilities in Oudomxay Province, Lao PDR.

To promote the utilization of maternal health services and reduce financial barriers, the Laos government introduced its "Free Maternal Health Services Policy" in 2012. This policy provides free maternal health services for pregnant women, which includes costs related to treatment, transportation, food fees, referral and an incentive for four antenatal care appointments. This study aims to ascertain the knowledge level regarding this policy among Lao women and determine their level of satisfaction with the maternal service provision. This is a cross-sectional study conducted in Xay district, La district, and Namore district of Oudomxay province, in August 2015. Three hundred and sixty women who delivered their children at the health facilities from July 2014 to June 2015 were randomly selected from the list of mothers who lived in each area. The majority of women had heard about the free delivery policy and knew that the main health services related to delivery and pregnancy were free of charge. Logistic regression analysis showed that education level (P=0.026), length of stay (P<0.0001) and receiving transportation support (P=0.005) had significant associations with the knowledge level. The women were highly satisfied with the quality of the services, health care providers, and health facilities. However, most mothers were not satisfied with accessibility to health facilities. To increase utilization of health facilities and reduce the maternal mortality ratio in rural areas, the government needs to improve people's education status and health care accessibility.

Healthcare in Myanmar.

Myanmar transitioned to a civilian government in March, 2011. Although the democratic process has accelerated since then, many problems in the field of healthcare still exist. Since there is a limited overview on the healthcare in Myanmar, this article briefly describes the current states surrounding health services in Myanmar. According to the Census 2014, the population in the Republic of the Union of Myanmar was 51,410,000. The crude birth rate in the previous one year was estimated to be 18.9 per 1,000, giving the annual population growth rate of 0.89% between 2003 and 2014. The Ministry of Health reorganized into six departments. National non-governmental organizations and community-based organizations support healthcare, as well as international non-governmental organizations. Since hospital statistics by the government cover only public facilities, the information on private facilities is limited. Although there were not enough medical doctors (61 per 100,000 population), the number of medical students was reduced from 2,400 to 1,200 in 2012 to ensure the quality of medical education. The information on causes of death in the general population could not be retrieved, but some data was available from hospital statistics. Although the improvement was marked, the figures did not reach the levels set by Millennium Development Goals 4 and 5. A trial prepaid health insurance system started in July 2015, to be followed by evaluation one year later. There are many international donors, including the Japan International Cooperation Agency, supporting health in Myanmar. With these efforts and support, a marked progress is expected in the field of healthcare.

Assessment of hand hygiene compliance after hand hygiene education among health care workers in Cambodia.

Health care-associated infection (HCAI) is the most frequent adverse event for hospitalized patients. Hand hygiene is a simple and effective solution to protect patients from HCAI. This study aimed to introduce hand hygiene to health care workers based on the World Health Organization guideline for reducing HCAI in Cambodia and to assess their behavioral patterns on hand hygiene. All health care workers at Kampong Cham provincial hospital had lectures and practice on hand hygiene in January 2012. The surveys for hand hygiene compliance (HHC) were performed after 6 months, 1 year and 2 years, respectively. The number of surgical site infections (SSI) was counted in 2011 and 2014. Our analysis used the data of 58 workers, who were observed at all three points, although 139 workers were observed during the study period. The average of HHC at 6 months, 1 year and 2 years were 62.37%, 85.76% and 80.36%, respectively. The improved group (HHC 2 years/1 year≧1) had 32 workers, whereas the worsened group (HHC 2 years/1 year<1) had 26. There was a significant difference in departments of the two groups (P=0.011) but not in sex, age or occupations. The improved group had more workers of General (31.2% vs. 19.2%), Surgical (25.0% vs. 11.5%) and Infection (21.9% vs. 11.5%) categories compared to the worsened group. The incidence of SSI was improved from 32.26% in 2011 to 0.97% in 2014. Our results suggest that the education and the survey on hand hygiene are effective for reducing HCAI in Cambodia.

Pediatric cardiothoracic program in Malaysia: a study based on the outcome of the program.

Vulnerable communities in Malaysia have been facing issues of accessibility and availability for pediatric cardiac services for years due to long waiting times, high costs and a lack of pediatric cardiothoracic surgeons. To ease this situation, the government has allocated a certain amount of funds, introduced through the Pediatric Cardiothoracic Program (PCP), in which the patients are transported to the Narayana Health Institute of Cardiac Science (NH) in India to receive a heart operation following an eligibility check at MediAssist4U Sdn Bhd in Selangor, Malaysia, a facility appointed by the NH. This study aimed to determine the demographic incidence of congenital heart diseases of patients in this program and to evaluate the outcome of the program in association with post-operative mortality rate and the beneficial factors of the program. In this study, 241 patients who participated in this program from August 2008 to September 2012 were reviewed. Fisher's exact tests were applied to calculate p-values of categorical data. Out of 241, 11 patients were rejected because of their poor health condition for flight transportation to India, leaving 230 patients for analysis. The majority of patients were 1 to 4 years of age (57.8%), Malays (61.7%), from families of monthly household income less than RM 1,500 (86.5%) and with primary school-educated parents (86.5%). Patients could apply from any government hospital in Malaysia, but 34.8% of the patients were from the state of Johor. The region (Peninsular Malaysia and East Malaysia) of patients seeking pediatric cardiac services was significantly associated with race (p<0.001), low household income (p<0.001) and low education background of parents (p=0.004). The associations between the age group and diagnosis group (p=0.010) and between duration of hospitalization and outcome of medical management (p=0.013) were significant. Post-operative mortality rate was 1.7% (95% confidence interval, 0.5-4.4). In conclusion, the patients and the government were considered to have benefited from the PCP.

Trends in attrition among medical teaching staff at universities in Myanmar 2009-2013.

Although lack of human resources for health is becoming a global problem, there are few studies on human resources in Myanmar. This study was conducted to investigate the attrition rates of teaching staff from universities for medical professions in Myanmar from 2009 to 2013. The data were collected from administrative records from Department of Medical Sciences, Ministry of Health, Myanmar. Numbers of staff and those who permanently left work (attrition) from 2009 to 2013 were counted. The reasons were classified into two categories; involuntary attrition (death or retirement) and voluntary attrition (resignation or absenteeism). Official records of the attrited staff were reviewed for identifying demographic characteristics. The annual attrition rate for all kinds of health workers was about 4%. Among 494 attrited staff from 2009 to 2013, 357 staff (72.3%) left their work by involuntary attrition, while 137 staff (27.7%) left voluntarily. Doctors left their work with the highest annual rate (6.7%), while the rate for nurses was the lowest (1.1%). Male staff attrited with a higher rate (4.6%) than female staff (2.7%). Staff aged 46-60 years had the highest attrition rate. PhD degree holders had the highest rate (5.9%), while basic degree holders had the second highest rate (3.5%). Associate professors and above showed the highest attrition rate (8.1%). Teaching staff from non-clinical subjects had the higher rates (8.2%). Among 494 attrited staff, significant differences between involuntary attrition and voluntary attrition were observed in age, marital status, education, overseas degree, position, field of teaching, duration of services and duration of non-residential service. These findings indicated the need to develop appropriate policies such as educational reforms, local recruitment plans, transparent regulatory and administrative measures, and professional incentives to retain the job.

Acute malnutrition among under-five children in Faryab, Afghanistan: prevalence and causes.

Acute malnutrition affects more than 50 million under-five (U5) children, causing 8.0% of global child deaths annually. The prevalence of acute malnutrition (wasting) among U5 children in Afghanistan was 9.5% nationally and 3.7% in Faryab province in 2013. A cross-sectional study was conducted for 600 households in Faryab to find the prevalence and causes of acute malnutrition. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using a logistic model. Demographic results of this study showed that 54.0% of the household heads and 92.3% of the mothers had no education. Three-fourths of households had a monthly income ≤ 250 USD. According to the measurement of weight for height Z-score (WHZ), 35.0% (210/600) of the children had acute malnutrition (wasting, WHZ < -2). In more than half of the households, water, sanitation, and hygiene (WASH) conditions were poor. When adjusted, a significant association of acute malnutrition among U5 children was found with the education level of household heads (OR=1.49; 95% CI, 1.02-2.17), age of household heads (OR=2.01; 95% CI, 1.21-3.35), income (OR=1.66; 95% CI, 1.04-2.27), education level of mothers (OR=2.21; 95% CI, 1.00-4.88), age of children (OR=1.99; 95% CI, 1.32-2.93), history of children with diarrhea in the last two weeks of data collection (OR=1.57; 95% CI, 1.10-2.27), feeding frequency (OR=3.01; 95% CI, 1.21-7.46), water sources (OR=1.89; 95% CI, 1.26-2.83), and iodized salt (OR=0.59; 95% CI, 0.39-0.88). The present study indicated that an increase in education level of parents, household income, and quality of WASH would result in a significant decrease in prevalence of wasting among U5 children.

Trends in amenable mortality rate in the Mongolian population, 2007-2014.

Amenable mortality (AM) is an indicator of medical care quality. This study aimed to assess the trend and magnitude of AM in Mongolia, with the purpose of providing evidence for decisions on resource allocation. This is the first study on AM trends in Mongolia. Retrospective analysis was done on mortality statistics for the period 2007-2014. Causes of death were coded according to the 10th revision of the International Classification of Diseases (ICD-10). Nolte & McKee's classification of AM was used for the estimation of amenable mortality rates (AMRs) in Mongolia. During the study period, a total of 130,402 deaths were registered in Mongolia, of which 44,800 (34.4%) deaths were classified as being amenable. The age-standardized AMR per 100,000 population was highest in 2007 (226.6), and declined continuously until the level of 169.2 in 2014. The rate remained consistently higher in males than in females. Cerebrovascular diseases, ischemic heart diseases, perinatal deaths, influenza/pneumonia/asthma and tuberculosis were the leading causes of AM in the past eight years in Mongolia. The AMR was higher in remote western provinces with harsh weather conditions, high poverty rates, lack of human resources for health, and poor infrastructure. In addition, the provinces where Mongolia's ethnic minorities live tended to have a higher AMR. The government of Mongolia needs to critically look at the regional differences in AM in order to allocate health resources, including human resources, effectively. Further studies are needed to look into the causes of regional disparities in AM, individual-level risk factors to amenable deaths, and validity of death coding in health sector.

Factors influencing contraceptive use among women in Afghanistan: secondary analysis of Afghanistan Health Survey 2012.

The increase in contraceptive use in Afghanistan has been frustratingly slow from 7.0% in 2003 to 11.3% in 2012. Data on contraceptive use and influencing factors were obtained from Afghanistan Health Survey (AHS) 2012, which had been collected through interview-led questionnaire from 13,654 current married women aged 12-49 years. Odds ratio (OR) and 95% confidence interval (CI) of contraceptive use were estimated by logistic regression analysis. When adjusted for age, residence, region, education, media, and wealth index, significant OR was obtained for parity (OR of 6 or more children relative to 1 child was 3.45, and the 95%CI 2.54-4.69), number of living sons (OR of 5 or more sons relative to no son was 2.48, and the 95%CI 1.86-3.29), wealth index (OR of the richest households relative to the poorest households was 2.14, and the 95%CI 1.72-2.67), antenatal care attendance (OR relative to no attendance was 2.13, and the 95%CI 1.74-2.62), education (OR of secondary education or above relative to no education was 1.62, and the 95%CI 1.26-2.08), media exposure (OR of at least some exposure to electronic media relative to no exposure was 1.15, and the 95%CI 1.01-1.30), and child mortality experience (OR was 0.88, and the 95%CI 0.77-0.99), as well as age, residence (rural/urban), and region. This secondary analysis based on AHS 2012 showed the findings similar to those from the previous studies in other developing countries. Although the unique situation in Afghanistan should be considered to promote contraceptive use, the background may be common among the areas with low contraceptive use.

Factors affecting maternal healthcare utilization in Afghanistan: secondary analysis of Afghanistan Health Survey 2012.

This study, a secondary analysis of data from Afghanistan Health Survey 2012, aimed to identify factors affecting maternal healthcare utilization in Afghanistan. Subjects were 5,662 women aged 15-49 years who had had one delivery in the two years preceding the survey. Odds ratio (OR) and 95% confidence interval (CI) were estimated by logistic regression analysis. The study found that 54.0% of mothers used antenatal care (ANC) at least one time, and 47.4% of births were assisted by skilled birth attendants (SBA). Adjusted OR of ANC use was 2.74 (95% CI, 2.08-3.60) for urban residency, 1.69 (95% CI, 1.26-2.27) for primary education relative to no education, 3.94 (95% CI, 3.51-4.42) for knowledge on danger signs of pregnancy, and 1.78 (95% CI, 1.47-2.15) for television and radio relative to no exposure. Adjusted OR of SBA utilization was 3.71 (95% CI, 2.65-5.18) for urban residency, 0.67 (95% CI, 0.48-0.91) for age <20 years relative to age 34-49 years, 1.43 (95% CI, 1.03-1.97) for secondary and higher education relative to no education, 1.83 (95% CI, 1.47-2.27) for para 1 relative to para ≥5, 6.66 (95% CI, 5.43-8.15) for ≥4 ANC visits relative to no visit, 1.37 (95% CI, 1.21-1.57) for knowledge of danger signs of pregnancy, 1.62 (95% CI, 1.38-1.90) for radio relative to no exposure, and 2.71 (95% CI, 2.25-3.27) for rich households relative to poor ones. Since women's education and knowledge about danger signs of pregnancy were significant factors of both ANC and SBA, educating women may be an effective step in promoting safe maternal health.

Associations of socioeconomic determinants with community clinic awareness and visitation among women: evidence from Bangladesh Demographic and Health Survey-2011.

BACKGROUND: Although Bangladesh has achieved tremendous success in health care over the last four decades, it still lagged behind in the areas of maternal and child malnutrition and primary health care (PHC). To increase access to PHC, the Bangladesh government established approximately 18,000 community clinics (CCs). The purpose of this study was to examine the associations of socioeconomic determinants of women aged 12-49 years with the CCs awareness and visitation. METHODS: We analyzed secondary data provided by Bangladesh Demographic and Health Survey-2011. A two-stage cluster sampling was used to collect the data. A total of 18,222 ever married women aged 12-49 years were identified from selected households and 17,842 were interviewed. The main outcome measures of our study were awareness and visitation of CCs. Bivariate logistic regression was used to calculate odds ratio (OR) and 95% confidence interval (CI) to examine the associations between the awareness and visiting CCs with socioeconomic determinants. RESULTS: Low prevalence of awareness about CC (18 %) was observed among studied women and only 17 % of them visited CCs. Significant associations (P < 0.05) with CCs awareness and visitation were observed among aged 20-29 years (adjusted OR = 1.18; 95% CI = 1.03-1.35 and adjusted OR = 1.49; 95% CI = 1.05-2.11), primary education (adjusted OR = 1.20; 95% CI = 1.08-1.34 and adjusted OR = 1.37; 95% CI = 1.05-1.78), and poorest family (adjusted OR = 1.21; 95% CI = 1.03-1.42 and adjusted OR = 2.36; 95% CI = 1.56-3.55, respectively), after controlling potential confounders. CONCLUSIONS: Awareness and visitation of CCs were found to be positively associated with lower economic conditions, young age, and primary education. Awareness and access to CCs might be increased through community activities that involve health care workers. The government should also lower barriers to PHC access through CCs by providing adequate logistics, such as human resources and equipment.

ROLES OF PUBLIC HEALTH CENTERS (HOKENJO) IN TUBERCULOSIS CONTROL IN JAPAN.

Public health centers (PHCs, hokenjo in Japanese) are local government authorities responsible for public health in Japan. PHCs have an important role in tuberculosis (TB) control. Typically, their responsibilities include 1) the recommendation to admit infectious TB patients to an isolation ward, 2) health checkups with chest X-ray of those in a close contact with infectious TB patients, and 3) public subsidy of medical expenses for TB treatments. Facing the emergence of multi-drug resistant tuberculosis (MDR-TB), the national TB control program was drastically changed; the Japanese version of the Directly Observed Treatment in Short-course (DOTS) strategy was started in 2005. New roles were added to PHCs' responsibilities; 1) active screening of latent TB infection by interferon gamma release assays for those in a close contact with infectious TB patients, 2) community DOTS to promote treatment adherence to outpatients, 3) cohort analysis of outcomes of TB treatment, and 4) national MDR-TB surveillance. These roles are important in preventing MDR-TB and eliminating TB in Japan.

Factors associated with access to antiretroviral therapy among people living with hiv in vientiane capital, lao pdr.

Since 2001, antiretroviral therapy (ART) has been available for people living with HIV (PLHIV) in Lao People's Democratic Republic (PDR). Over 10 years of the ART program many HIV patients were found with advanced-stage AIDS in health care service facilities. This study aimed to examine factors associated with delayed access to ART among PLHIV in the capital of Vientiane. A cross-sectional study was conducted with 283 respondents (131 males and 152 females) aged 15 years or over. In this study, delayed access to ART was defined by a CD4 cell count of less than 350 cells/mm(3) at the first screening, or those who presented with advanced AIDS-related symptoms. The odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by a logistic model. After adjustment, young people (OR=2.17; 95% CI: 1.00-4.68; p=0.049), low education (OR=0.23; 95% CI: 0.10-0.55; p=0.001) and duration between risk behavior and HIV test (OR=3.83; 95% CI: 1.22-12.00; p=0.021) were significantly associated with delayed access to ART. Low perception of high risk behaviors was one of the obstacles leading to delayed testing and inability to access ART. Almost all reported feeling self-stigma, and only 30.5% of men and 23.7% of women disclosed the HIV status to his/her partner/spouse. In conclusion, delayed access to ART was associated with individual factors and exposure to health care facility. In order to improve early detection HIV infection following access to ART, an improvement in perceptional knowledge of HIV, as well as reduction of HIV/AIDS-related stigma, might be needed.

Delivery care satisfaction at government hospitals in xiengkhuang province under the maternal and child health strategy in lao pdr.

Satisfaction with delivery care for mothers giving birth at medical facilities, particularly hospitals, affects birth place selection. Lao PDR faces high maternal and infant mortality, and the government had introduced the Maternal and Child Health Strategy to Xiengkhuang Province in 2009 to combat high maternal and infant mortality there. This study aimed to determine the levels of delivery care satisfaction among mothers who gave birth in hospitals and examine the associations between satisfaction and background factors. This was a cross-sectional study, conducted from July to August of 2013, for 246 mothers who gave birth at three hospitals. A logistic regression model was applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of the factors. The majority of respondents were ≤ 25 years of age (57.3%), educated in ≤12 years (64.2%), unemployed (77.6%), and with more than one child (60.2%). Most mothers (93.5%) received antenatal care at least one time. Among the 16 components of satisfaction, less than half of the respondents were satisfied with sanitary facilities (22.0%), cleanliness (39.4%), their infant's health condition (42.7%), opportunity to clarify doubts about baby care (48.8%), their own health condition (43.5%), and privacy maintained during care (45.5%). The components with more than 80% satisfaction among the respondents were the politeness and respect shown by midwives (88.6%), nurses (85.4%), and doctors (80.1%) as well as medical service facilities (81.7%). Overall satisfaction was significantly associated with higher husband's education (OR=2.36, 95% CI=1.07-5.19) and longer hospital stay (OR=2.30, 95% CI=1.28-4.14) when 15 background factors were adjusted. In conclusion, mothers who gave birth at hospitals in Lao PDR were generally satisfied, except for sanitary facilities, and cleanliness of facilities.

Clinical features, current treatments and outcome of pregnant women with preeclampsaia/eclampsia in northern afghanistan.

In Afghanistan, preeclampsia/eclampsia is the second leading cause of maternal deaths following maternal hemorrhage. This study aimed to describe clinical features, current treatments, and outcome among preeclampsia and eclampsia patients in the north region of Afghanistan. This was a retrospective study based on medical records of four center hospitals (one regional hospital and three provincial hospitals) in the north region of Afghanistan. Subjects were 322 patients with preeclampsia/eclampsia, admitted from March 2012 to March 2013. Out of 322 cases, 72.7% were diagnosed as preeclampsia and the rest as eclampsia. Those aged 30-39 years were 41.0% among preeclampsia patients and 29 years and younger were 35.2% among eclampsia patients (p= 0.002). The first delivery was significantly higher (p=0.045) among eclampsia patients (51.1%) than among preeclampsia patients (36.8%). While none died among the preeclampsia patients, 12 out of 88 eclampsia patients died in the hospitals. The causes of the 12 deaths were pulmonary edema (6 patients), renal failure (3 patients), cerebrovascular attack (2 patients), and hemorrhage (1 patient). There were no clinical findings at admission significantly associated with the deaths within the eclampsia patient group. Although the sample size was not large enough, patients admitted to the regional/provincial hospitals at the stage of preeclampsia had a low risk of death. Access at the stage of preeclampsia and improvement in treatments for eclampsia would reduce maternal mortality in Afghanistan.

Progress toward measles elimination in kyrgyzstan.

Measles is one of the most severe infectious diseases of childhood, and one of the major causes of mortali-ty, especially in developing countries. Despite rare measles outbreaks in recent years, Kyrgyzstan seeks to show its commitment towards the global anti-measles campaign. The aim of this article is to summarize the scattered information on the recent status of measles, valid surveillance system, and measles elimination strategies in Kyrgyzstan, based on sources that include non-confidential but usually inaccessible governmental data. Infor-mation was extracted from the reports to the Ministry of Health and documents on the national surveillance system, in addition to outbreak cases extracted from the Republican Infectious Diseases Hospital's archive. To tackle the worsening measles situation in Kyrgyzstan, the Ministry of Health established the Republican Center for Immunoprophylaxis in 1994. Measles related death, which was rampant up until 1992, has not been registered since 2000 due to improved routine vaccination coverage, increasing from 88% in 1994 to 97% and over in 1997. The national surveillance system was modernized thanks to the World Health Organization, helping to detect measles cases and prevent major outbreaks. The system identified 222 cases in the outbreak of 2011, and the case cards in the hospital provided the findings of 69 admitted cases (42 infants, 22 children aged 1 to 14 years, and 5 aged 15 years or over), including 32 severe cases. This article provides a whole view on measles in Kyrgyzstan, which would be useful to control measles worldwide.